Healthcare Provider Details

I. General information

NPI: 1487190674
Provider Name (Legal Business Name): CLEVERMED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4188 LAKE SHORE RD
HAMBURG NY
14075-2044
US

IV. Provider business mailing address

4188 LAKE SHORE RD
HAMBURG NY
14075-2044
US

V. Phone/Fax

Practice location:
  • Phone: 716-844-1051
  • Fax: 888-974-1108
Mailing address:
  • Phone: 716-844-1051
  • Fax: 888-974-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CORY DOWNEY
Title or Position: SOLE MEMBER
Credential:
Phone: 716-844-1051